
Mary Ann Joyce had just finished playing a round of golf last March when she felt a sharp pain in her left heel. “I didn’t feel it on the course, but as soon as I changed shoes afterward, it was there,” says Joyce, now 68. The Frankfort, Ill., resident, who was vacationing in Florida at the time, immediately made a podiatrist appointment. The diagnosis: plantar fasciitis.
An inflammatory condition of the tissue on the bottom of the foot, plantar fasciitis (pronounced fash-ee-EYE-tus) is the most common cause of heel pain, affecting about 2 million Americans every year. It can be difficult to treat, but it is almost always curable through conservative measures.
“Ninety-nine percent of the time, you can resolve symptoms through nonoperative treatments,” says Keith Wapner, MD, clinical professor of orthopedic surgery at the University of Pennsylvania. For Joyce, six weeks wearing an immobilizing orthotic boot, followed by physical therapy to stretch and strengthen the muscles of her calves and feet, did the trick. Her symptoms disappeared in three months.
Here’s how to tell if you’re at risk for plantar fasciitis, along with some tips for prevention and treatment.
When Plantar Fasciitis Strikes
The plantar fascia is a thick, flat band of connective tissue that spans the sole of the foot, connecting the heel bone to the toes and supporting the arch. The exact cause of plantar fasciitis is unknown, but most experts believe excessive tension or stress creates small tears in the tissue, which then becomes inflamed.
The hallmark symptom, sharp heel pain, usually starts with the first steps in the morning or when standing after periods of rest. “As plantar fasciitis progresses, you still have startup pain, but it hurts more often,” Wapner says. “Eventually, it hurts all the time.”
Anyone can develop plantar fasciitis, but the following factors increase your risk:
Tight calf muscles: When your calf is tight, it pulls on your Achilles’ tendon and creates tension on the plantar fascia.
Improper footwear: Shoes that are overly flexible at the arch can increase pressure on the plantar fascia. Calf-tightening high heels also contribute to the problem.
Overtraining or a rapid increase in mileage: Increasing mileage by more than 10 percent per week can make runners more prone to developing plantar fasciitis.
Faulty biomechanics: “Overpronation [landing on the outside of your foot and rolling in] causes a lot of tension when the heels and toes lift off the ground,” says Stephen Pribut, DPM, a Washington, D.C., podiatrist and past president of the American Academy of Podiatric Sports Medicine. Movement problems at the hip or trunk can also lead to compensation patterns.
Excess weight: Studies have found that overweight people were more likely to develop plantar fasciitis because of added stress to the tissue and joints.
Heel-ing Powers
As with most overuse injuries, you can’t expect to resolve plantar fasciitis overnight. Seek treatment as soon as you feel heel pain — a medical professional can formulate a treatment plan incorporating the following strategies:
- Stretch it out. “The basic tenet of treatment is increasing flexibility in both the gastrocnemius, which is the large calf muscle that forms the Achilles’ tendon, and the plantar fascia itself,” says Wapner. (See “Foot Fixes,” below, for suggestions.)
- Upgrade your footwear. Avoid high heels and flip-flops, and wear supportive shoes even around the house. Some patients find relief in orthotics, which support the arch and distribute pressure in flat feet or high arches.
- Try massage. Myofascial techniques can soften tough, inflexible tissue and increase blood flow, Marcus says. Try rolling your foot over a tennis ball. (Start gently!)
- Wear a night splint. “A splint keeps your foot dorsiflexed so you don’t spend eight hours reversing the stretching you’ve done,” says Wapner. Two studies published in Foot & Ankle International found night splints had an 80 percent success rate in reducing plantar fasciitis symptoms.
- Apply ice. Icing the plantar fascia helps soothe pain and reduce inflammation. For a DIY ice massage, roll your foot over a frozen water bottle or use an ice-filled paper cup.
- Strengthen your feet. Some experts believe you can strengthen the muscles on the bottoms of your feet to take the pressure off the plantar fascia.
“For severe cases, your doctor might recommend a corticosteroid injection to help reduce pain and inflammation, though the injection can make the plantar fascia a bit more prone to rupture,” says Edward Laskowski, MD, codirector of the Mayo Clinic Sports Medicine Center in Rochester, Minn. And there is a surgical option that cuts the plantar fascia from the heel bone, though this is rarely performed, and experts advise at least a year of noninvasive therapy before even considering that route, which can lead to further complications.
Make an Active Recovery
You can continue to exercise with plantar fasciitis, but Laskowski suggests that you avoid sports that involve heavy pounding and replace them with low-impact activities such as swimming or riding a stationary bike. Runners who find it unrealistic to abandon their sport can try reducing mileage, provided their gait is not affected.
But the rule is, if it hurts, don’t do it. “If you keep going when you feel pain, it’s going to get worse,” says Curt Marcus, PT, DPT, the Chicago-area physical therapist who treated Mary Ann Joyce. Listen to your body and follow a treatment plan consistently. And be patient: About 90 percent of plantar fasciitis cases resolve within two months, so your chances of getting better are excellent.
Thank you for sharing your knowledge and expertise on this important topic.
Thanks for the nice tips, there are some here that i have already known but you have pointed out a few new ones that i plan to add to my daily regimens, i hope it works!
Thanks for bringing to my attention that improper footwear can lead to plantar fasciitis. I’ve been having some issues with heel pain, and it started a little bit after I bought new shoes. Perhaps it would be a good idea to visit a podiatrist to get that taken care of, and maybe I could get custom orthotics so they fit better.
Actually, this is a very informative article. It does provide me with many helpful exercises to practice such as preventive or stretching techniques. In fact, I haven’t done all of them yet. But if I don’t do those, I shall definitely recognize something wrong and troublesome happening to my health, my body. It might be a kind of cramping which is very annoying and hurtful. According to my own experience, I suggest you guys, who get Plantar Fasciitis, should take those kinds of preventive action in order to prevent unexpected problems in the future.
This is some great information, and I appreciate your suggestion to stretch out your foot to help with plantar fasciitis. My right foot has been causing me a lot of problems with pain recently, so I’m going to be visiting a podiatrist in about a week. In the meantime, I’ll definitely try doing a few of the stretches shown here to try and help. Thanks for the great post!
When you get pain in your feet it can be very difficult to deal with and get rid of. I like what you talked about stretches you can do to help relief pain in your heels. It seems if these don’t help it would be smart to go see a foot doctor.
My son hurt his foot in football practice the other day, and he has no idea how to treat it. That being said, I really appreciate you sharing with me some great insight on things he cans start doing to ease the pain he’s been feeling. I’ll make sure I show him this so he can begin working on it. Thanks a ton for sharing this with me.
I totally disagree with rolling a tight fascia over a frozen bottle. If you are trying to stretch a muscle it should be warm. Not cold. I had PF for two years many years ago and didn’t get well because of poor advice from multiple practitioners. Massage, stretching and strengthening the foot muscles pulled me out of it.
I have excruciating pain in my left calf muscle. It keeps me awake at night
and I am finding it difficult to walk. My foot is cold and my toes have
little feeling. Help
Hi Carolyn,
We are not medical experts. We advise you to seek advice from a doctor right away for help treating your condition.
Thanks.
Heidi
I had a terrible bout of PF from wearing flat shoes and flip flops all summer. I could barely walk in the morning. I saw a wonderful chiropractor in Minneapolis (Mark A. Johnson) for what I thought was unrelated back pain. Turns out the whole system was going out of whack because of how bad my feet hurt. After a phenomenal description of how this muscle affects that one and the pain in your shoulder is really caused by your limp, a few adjustments and some very simple stretching (rolling feet on golf ball while watching TV, wall leaning stretches)along with a lecture about wearing flip flops (absolutely no) and putting arch supports (even just the little skinny kind) in my ballet flats I now am pain free. If I start to get lazy and stop wearing my arch supports, my feet start to ache within hours. The Pedaq holiday fits nicely into the slimmest flats and I go no where without them anymore.
Working retail on a concrete floor contributed to a very painful bout of plantar fasciitis for which I had a couple of steroid shots in my heel. Ouch! Helped. But I credit Dansko clogs (I was skeptic when nice shoe man suggested a pair) for making a huge difference. Good luck to anyone who’s suffering…